Long-Term Care Facility HAI Toolkit

On this page:

Infection Control Resources

• Antimicrobial stewardship
• Handwashing and environmental cleaning
• Rules
  • Interfacility transfer rule
  • HAI reporting
• General training and resources

Organism Specific Resources

• Multidrug resistant organisms
• Norovirus
• Respiratory conditions
• Urinary tract infections/ Catheter associated urinary tract infections

Infection Control Resources

Antimicrobial Stewardship

• AHRQ's Nursing Home Antimicrobial Stewardship Guide
  Guidance: This guide provides toolkits to help nursing homes optimize their use of antibiotics

• California Department of Health ASP in Nursing Homes
  Toolkit: Tools and resources from California Department of Public health HAI program including examples of program implementation and a webinar series
  

• CDC's Core Elements of Antibiotic Stewardship for Nursing Homes
  Guidance: Nursing homes are encouraged to work in a step-wise fashion, implementing one or two activities to start and gradually adding new strategies from each element over time. Any action taken to improve antibiotic use is expected to reduce adverse events, prevent emergence of resistance, and lead to better outcomes for residents in this setting
  

• CDC Train: Antibiotic Stewardship in Nursing Homes
  Training: This module discusses overuse of antibiotics and adverse events in nursing homes and offers support in implementing the core elements of antibiotic stewardship programs
  

• Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care Facilities 
  Toolkit: This toolkit offers concrete tools that could help facilities recognize their baseline antimicrobial stewardship capacity and enhance their existing assessment, documentation, and communication processes
  

• Oregon AWARE Provider Resources
  Resources: This webpage provides links to prescribing recommendations for upper respiratory tract infections and online training modules that introduce communication techniques to use during antibiotic stewardship interactions

• Oregon Statewide Antibiogram
  Resource: This report presents all statewide data together for gram-positive and gram-negative organisms and breaks down the data by region, providing separate reports for the Portland Tri-county area and the rest of Oregon excluding the Portland Tri-county area
  

• Quality Improvement Organizations Nursing Home Training Sessions
  Training: These training sessions support implementation of principles and practices of antibiotic stewardship, prevention and management of C. difficile infections and communication strategies and tools to promote quality and safety

Hand Hygiene and Environmental Cleaning

Hand Hygiene

• CDC's Hand hygiene in health care settings
  Online training: Review key concepts of hand hygiene and standard precautions

• Assessment of Current CDI Prevention Activities - Hand Hygiene (pdf)
  Check list: Assess knowledge and competency, infection prevention and infrastructure and monitoring practices related to hand hygiene

• WHO: Hand hygiene: Why, How and When (pdf)
  Educational tool: Info-graphic rich guide to the 'Why, How and When' of hand hygiene, including the WHO '5 Moments'

• Guidelines for Hand Hygiene in Healthcare Settings (pdf)
  Guidance: 2002 CDC Morbidity and Mortality Weekly Report on hand hygiene guidelines for health care settings

• WHO: "Clean Care is Safer Care"
  Toolkit: Support health-care facilities in improving hand hygiene practices among health-care workers

Environmental Cleaning

• OHA Ventilation Toolkit helps facilities understand how air flows through their building and steps to take for a healthier environment. Want to see it in action? Watch the video for a visual representation of the toolkit's content. 
  
• EPA's Registered Antimicrobial Products Effective Against Clostridium difficile Spores
  Cleaning product list: These products carry an EPA label as being effective at removing C. difficile spores

• CDC's Options for evaluation Environmental Cleaning
  Evaluation tool: Website on processes for assessing cleaning practices

• Oregon Patient Safety Commission's Norovirus: Training for environmental cleaning staff
  Online training video: Walk through important information about norovirus, how it spreads, and how to prevent the spread of the virus by swiftly implementing best-practice infection prevention measures

• CDC's Environmental Cleaning and Disinfecting for MRSA
  Information and resources: All you need to know about cleaning and disinfecting for MRSA

Rules

• Interfacility transfer communication
  Information and resources: As part of best practice during patient transfers, information about a patient's medical status, including colonization or infection with a multidrug-resistant organism, should travel with a patient and be readily available to medical providers

• Healthcare Acquired Infection Reporting
  Information and resources: The Oregon Health Authority (OHA) provides oversight and support for mandatory HAI reporting activities in Oregon hospitals.

   

  Oregon hospitals report HAIs using the National Healthcare Safety Network (NHSN) reporting tool. This includes the reporting of CLABSIs, certain kinds of SSIs, and several healthcare facility process measures designed to ensure quality and to reduce HAIs.

General Training and Resources

• Getting Ready for Influenza and Norovirus: Key Information for Long-term Care Facilities (LTCFs)
  Webinar Recording: Provides information about influenza and norovirus symptoms, modes of transmission, and strategies to prevent spread. Introduces and explains a new law promoting recognition, reporting, and control of disease outbreaks in LTCFs. Reviews current recommendations from Oregon Health Authority regarding transfer of recovering influenza and norovirus patients from hospitals to LTCFs. 

• Tracking Infections for Long-term Care Facilities
  Resources and toolkits: CDC's National Healthcare Safety Network provides long-term care facilities with a customized system to track infections in a streamlined and systematic way.

• Early Identification/Containment Assessment Checklist (pdf)
  Process and practice checklist: Assess nursing home processes and staff practices for identification and diagnosis of CDI and implementation of appropriate precautions to limit spread of C. difficile

• AHRQ Improving Patient Safety in Long-term Care Facilities
  Training module: Help nursing home staff detect and communicate changes in resident conditions

• Nursing Homes and Assisted Living Facilities
  Facility resources: CDC resources for LTCFs

Organism Specific Resources

Multidrug Resistant Organisms

MDRO stands for multidrug-resistant organism. An MDRO causes human disease which has acquired antibiotic resistance, as listed and defined by the Centers for Disease Control and Prevention (CDC) in Antibiotic Resistance Threats in the United States, 2013 (pdf).

• View a list of selected MDRO definitions (pdf)
• Recommendations for specific MDROs
  Toolkit and Recommendations: This webpage provides recommendations for specific MDROs and a link to the Oregon MDRO Toolkit

Carbapenem-resistant Enterobacteriaceae (CRE)

• Carbapenem-resistant Enterobacteriaceae (CRE)
  Recommendations and information: A brief overview of CRE from OHA

• Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE) 2016 Oregon Tool Kit
  Toolkit: Page 16-23 of the offers specific recommendations for skilled nursing facilities

Clostridium difficile

• Clostridium difficile
  Recommendations and information: A brief overview of Clostridium difficile from OHA

• CDC's C. difficile
  Information and resources: Broad overview of C. difficile from the CDC with information for patients, providers, and healthcare facilities
• Advancing Excellence C. difficile Infection Prevention Assessment Checklists
  Checklist: CDC resource for preventing and containing C. difficile

• Early Identification/Containment Assessment Checklist (pdf)
  Checklist: Assess nursing home processes and staff practices for identification and diagnosis of CDI and implementation of appropriate precautions to limit spread of C. difficile

Methicillin Resistant Staphylococcus aureus (MRSA)

• Methicillin Resistant Staphylococcus aureus (MRSA)
  Recommendations and information: A brief overview of MRSA from OHA

• CDC's General Information About MRSA in Healthcare Settings
  General Information: Risk factors, causes, and prevention

• CDC's Environmental Cleaning and Disinfecting for MRSA
  Information and Resources: All you need to know about cleaning and disinfecting for MRSA

• APIC's Guide to the Elimination of Methicillin- Resistant Staphylococcus aureus (MRSA) in the Long-Term Care Facility (pdf)li>

Vancomycin Resistant Enterococci (VRE)

• Vancomycin Resistant Enterococci (VRE)
  Recommendations and information: A brief overview of VRE from OHA

• VRE infection control guidelines
  Guidelines from New York State Department of Health: Care of patients colonized or infected with VRE in hospitals, long-term care facilities and home health care

Norovirus

• Norovirus Outbreak Detection and Management (pdf)
  Toolkit: Oregon Health Authority toolkit specifically for long term care facilities
  

• CDC's Norovirus in Healthcare Settings
  Toolkit: Symptoms, transmission and prevention of Norovirus and a list of resources

• Oregon Patient Safety Commission's Norovirus: Training for environmental cleaning staff
  Online training video: Walk through important information about norovirus, how it spreads, and how to prevent the spread of the virus by swiftly implementing best-practice infection prevention measures

• Norovirus in long-term care facilities
  Information: Oregon Public Health Division annotated report of stakeholder meeting and interviews

Respiratory Conditions

• Healthcare Provider Influenza Vaccination Tool Kit
  Toolkit: Oregon Health Authority toolkit specifically for long term care facilities

CDC resources

• Influenza Toolkit for Long-Term Care Employers
• Interim Guidance for Influenza Outbreak Management in Long-Term Care Facilities
• Summary Guidance for Flu Outbreak Management in LTCF (pdf)

Outbreaks in long-term care facilities (LTCF)

• Oregon Patient Safety Commissions Managing Influenza Outbreaks in Long-term Care Faciliites
  Online training video: This 11-minute training provides general information about influenza (the “flu”) and reviews specific ways to prevent and control outbreaks in long-term care facilities
• Facility Control Measure Report for Flu Outbreaks (pdf)
  Tool: Influenza outbreak control measure report for LTCFs

• Influenza Outbreak Control in Long Term Care Facilities (pdf)
  Educational tool: Cheat sheet for flu outbreaks

• Managing gastroenteritis outbreaks and infection control in long-term care facilities (LTCFs)
  Toolkit: How to manage a gastroenteritis outbreak in a LTCF

Sample letters / Alerts

• Letter of notification for residents of independent or LTCF advising prophylaxis (.doc)
• Letter of notification and request for providers to use prophylaxis (.doc)
• Sample provider alert (.doc)

Urinary Tract Infections/Catheter Associated Urinary Tract Infections

• CDC's CAUTI Prevention Guidance and Resources
  Toolkit Implementation Guide: Links to Example Resources

• AHRQ Toolkit: Determine Whether it is Necessary to Treat a Potential Infection with Antibiotics
  Toolkit: Medical care referral form

• CDC's Urinary Tract Infection (UTI) Event for Long-term Care Facilities
  Guidelines and Treatment Algorithms: How to track, report and manage UTIs in a LTCF